Secondary hematoma expansion in intracerebral hemorrhage during rivaroxaban therapy

摘要

Hematoma size is a key prognostic parameter in intracerebral hemorrhage (ICH); hence, secondary hematoma enlargement is an important event. Hematoma enlargement occurs more frequently and over a prolonged period in ICH patients on vitamin K antagonists compared with nonanticoagulated patients. So far, little is known about the natural history of ICH associated with new oral anticoagulants. Here, we present a 76-year-old woman anticoagulated with rivaroxaban who presented with a computed tomography showing a right basal ganglia ICH with ventricular extension. Although prothrombin concentrate was administered to reverse anticoagulation, follow-up cranial computed tomography demonstrated secondary hematoma enlargement. The patient deteriorated and died 10 days after from further rebleeding and consequently withdrawal of lifeprolonging therapy. Postmortem examination revealed no specific cause of bleeding.